Opioid titration with sustained-release oxycodone and immediate-release morphine for moderate/severe cancer pain: a pilot assessment of the CoDem protocol

Authors: Samolsky Dekel BG et al

Published in Journal of Opioid Management 10 (1), 29-38 (Jan-Feb 2014)

OBJECTIVES:

Opioid titration is the first challenging stage for rapid control of moderate/severe cancer pain. Evidence shows that sustained-release formulations may be used for opioid titration. We set a pilot assessment of the efficacy and tolerability of our in-house protocol (continuous and on demand opioids [CoDem]) of the association of sustained-release oxycodone and immediate-release morphine as rescue dose for opioid titration/rotation in opioid-naïve (NAOP, n = 13), tolerant to weak (WOP, n = 20), or strong opioids (STOP, n = 44) in-patients with moderate/severe cancer pain.

METHODS:

Observational and retrospective analysis of cancer in-patients treated for greater than 7 days with the CoDem protocol.

OUTCOME MEASURES:

Pain intensity (patients self-reported pain with numerical rating scale [NRS] under static [NRSs] and dynamic [NRSd] conditions), amount of drug consumption, opioid adverse effects, and patient satisfaction.

EFFICACY ENDPOINTS:

In more than 50 percent of the patients and in less than 72 hours, steady NRSs and NRSd score reduction of at least two points, NRSs less than 3 and NRSd less than 4; and mean daily morphine consumption less than mean of one rescue dose and t1:t6 ratio of mean oxycodone daily dose less than 1:2.

RESULTS:

Endpoints were reached within 24 hours both within the sample and subgroups. Only NAOP patients reached NRSd less than 4 endpoint within 48 hours. Against moderate and transient adverse effects, most patients (84.4 percent) found pain treatment to be good or excellent.

CONCLUSIONS:

The CoDem protocol was shown to be effective and reasonably tolerated for titration for moderate/severe cancer pain relief in both opioid-naïve or opioid-tolerant cancer in-patients. This pilot assessment warrants prospective and comparative studies with larger samples for more generalized results.